Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

• Published in: BJS open Vol. 7; no. 6
• Main Authors: Russell, Thomas B, Labib, Peter L, Denson, Jemimah, Streeter, Adam, Ausania, Fabio, Pando, Elizabeth, Roberts, Keith J, Kausar, Ambareen, Mavroeidis, Vasileios K, Marangoni, Gabriele, Thomasset, Sarah C, Frampton, Adam E, Lykoudis, Pavlos, Maglione, Manuel, Alhaboob, Nassir, Bari, Hassaan, Smith, Andrew M, Spalding, Duncan, Srinivasan, Parthi, Davidson, Brian R, Bhogal, Ricky H, Croagh, Daniel, Dominguez, Ismael, Thakkar, Rohan, Gomez, Dhanny, Silva, Michael A, Lapolla, Pierfrancesco, Mingoli, Andrea, Porcu, Alberto, Shah, Nehal S, Hamady, Zaed Z R, Al-Sarrieh, Bilal A, Serrablo, Alejandro, Aroori, Somaiah
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.11.2023
• Subjects: Humans; Pancreas - surgery; Pancreatic Fistula - epidemiology; Pancreatic Fistula - etiology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - methods; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Retrospective Studies
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1093/bjsopen/zrad106

Abstract Background Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P < 0.0001) and a classic Whipple approach (P = 0.005) were all associated with increased overall morbidity. In addition, ASA grade > II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens. Our multicentre study of pancreatoduodenectomy outcomes calculated the incidence and severity of all recorded complications (all classified using Clavien–Dindo and international definitions). Overall morbidity, major morbidity, pancreatic fistula, postoperative haemorrhage and 90-day mortality rates were 53 per cent, 17 per cent, 11 per cent, 6 per cent and 4 per cent, respectively. A high BMI and a high ASA grade correlated with the adverse perioperative outcomes studied.